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Home My WebLink About64-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES Ws17LtAPp9►$iTtcpPn UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. .....Z..54......... Date ..........................kni 1..2.............195.7... Permission is hereby granted to: (ACAS'£'o..VIOUte.ely............................................... ......m4al tl.. -po....................................I............... ..................TL3at..;SOI'Soria......uhy.w.................. to ... ............................................................. ................................................................................................................................................................ at premises located at ...IV.S...:iF31t1.."OEtd..�...£tr�?}L.R...25.).............................................................. .......................................East....arlon:......f,.Y. ................................................................................ ................................................................................ pursuant to application dated ..............................July••••�...............19.Gjj..., and approved by the Building Inspector. Fee $..5*00............ Building Inspectar.... � FOI~M NO. 1 TOWN. OF SOUTHOLD BUILDING DEPARTMENT TowJ',I CLERK'S ~0~FJ~;~E "~'~'~ SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Dote....J~A.~.. ......... .~...7.. ........................ 19..~.~.,.... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be 8fawn on the diagram which is part of this location. c. The work covered by this application may not be commenced before issuat3ce of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, N~w York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described· The applicant agrees to comply with all applicable laws, ordinances and regulations~ ..... ........... [,b4':ature c~/opplicant, or nome, i~ ~tion) .~ .......... ~.~ aa. :. ~..~.~.~.~..,...~:..g... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder. ........ ~...U...f:L/.,~.~.., ............................... ...cT...~.:.?..~...R.. ft..~. ~..o..~,, .................................... Name of owner of premises.....~..~.~..~./.X.~.~..'. ........... ~..~....~...~.:J...~..,J~.~.. ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done· Map No....................~-'"'-' .... ....... ........ Block .................................. Street and Number ..~.~.././~..../~..Q.I~..~......-.....,~...~..~...~..../.*~,~.~./.~. ~ ~ ../~..., .~.., , 2. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and ............................................................................................. /..~.,~...~.. ........... b. Intended use and occupancy ......... .~...~.....~. ................... ~ ............. ..~....~....~...~...~.....,~..~...: ............ 3. Nature of work (check which applicable): New Building .i .................. Addffion ............. Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... ~ Fee ..~-'....~ ........................................................ ....~--L6~ ............. (to be paid on filing this ~plic~¥i~'~) ...... 4. Estimated Cost FEES: 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commericol or mixed occupancy, specify nature and extent of each type of use ................................ Ye. --Fr°nt'"~"~'~'"" ..... Rear ...... -- ''~.~...,. ...... Depth ........~'....~. ~.... .... 7. Dimensions of existingHeight ...~...Q ................. structureS,Number ofif %~ i~ Dimensions of same structure with alterations or additions: Front ........ '.~..~....~..... Rear ........~(..c-l....,~....~.... ..... Depth .~.Z.O..~.~.~..~././'/.~/.~ Height ...¢../¢../....~... Number of Stories ...~../N..~ 8. Dimensions of entire new construction: Front ............. ~ ........ Rear ......... ~ .............Depth ........~....o. ................ Height ............................ Number of Stories ............................ 91' ~Size of lot: Front ...... L..~...(~.~.... ~:$ear ..... '/"/"7'"~'" .....Depth ....~...~..0...~... .... 10. Zone or use district in which pr%raises are situated....' .'.~..'.'......~.....' .......... ~'~...:.~..Lv .~.3 ..................................... proposed construction v'~late any zoning law, ordinance or,regulation? ....... .,'~....~.. ..................... : ............. 11. Does 12. Nome of Owner of premises..~...~...G..~:....¢g.Q.(4.~,~ress .2'..~.~.[A]....,~.~.~..~.. ........... Phone Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor ....... ~..~.~.;. ................................ Address ............. ~..! ........................... Phone NO ...... t.(. .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot, Por,~¢ # STATE OF NE~ YOlk(, i ~ ) ~ S. - -' ~')'~]'~1~ .... - ' COUNTY 0¢~..¢* ' ~ -' ' ' ' "' ' ' U, ...................... ~.~/.~ ....... ~ .......... being duly sworn, deposes end says th~t he is the epplicont (Name o, individ~, signing ~i? { above named. He is the ....... ~.......~ ~ v v , ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me tF~is Notary P. OB~i c'~~~t Y' ~y Ccmml:,slon Expire~ Ma~h 80,